So They're Not Accredited, But They Are

At Support For Home In-Home Care, we think know we are pretty darn good at providing home care to our clients, whether they are seniors who want to age in place or folks recovering from surgery or people with disabilities who need help with Activities of Daily Living (ADLs).  We also know that we are still learning -- and we intend to be in that mode for as long as we are in the senior care industry!

One of the firms that we have no problem learning from is Accredited Nursing, in Southern California.  Barry Berger heads the operation, but we also have a lot of contact with Neil Rotter, who knows more about ethical marketing than just about anyone else we have met.  These two folks, with whom I have the privilege of serving on a committee of the California Association for Health Services at Home (CAHSAH), are truly leaders in the home care and home health arenas.

What makes that so?  Well, one of our major issues with some other home care agencies is that their focus is all about the specific home care services that they provide.  For us, at Support For Home, our focus is one the comprehensive plan of care for our clients that goes beyond our services to include home safety, home health (including skilled nursing and physical therapy), durable medical equipment and so forth.  We provide -- any home care company provides -- only a slice of the overall "pie" that represents a client's needs.

Accredited Nursing "gets it."  They provide a wide variety of services -- check out their Web site, linked above -- but they also focus on, as we do, protecting the client and the client's family, by being the employer of record for their caregivers.  That means the family does not have to worry about taxes, workers compensation, unemployment insurance, liability insurance and so forth.

So, if I live in the Sacramento region and need home care, I am calling Support For Home.  If I'm in the LA area, you can count on the fact that I am talking to Accredited.

Best wishes, Bert

The Second Hardest Job: Professional Caregiver

Since we started Support For Home In-Home Care, we have consistently said that the hardest job in the world is that of the family caregiver.  From the beginning, we were aware of the fact that over 60% of family caregivers die before the person for whom they are caring.  We still firmly believe that, from our own families' stories, as well as working with our clients and their families.

When the business began, my folks needed some support to stay at home safely and with a high quality of life.  Over the past few years that need increased, and my two sisters up in Oregon were fantastic about ensuring they got what they needed.  Unfortunately, both of my parents passed away this year, but the hard work and devotion of my sisters were critical to helping them and the rest of us through that experience.

Even before our home care agency was rolling, my co-owner's experience was a critical learning experience.  Her father had a stroke in his early 90s, and her mother was the primary caregiver.  Her mother was younger, but the stress on her, physically and emotionally, were dramatically apparent, including developing Diabetes.

But, if being the primary, family caregiver is the hardest job in the world, being a professional caregiver / Home Care Aide, is a pretty close second.  That is so not just because of the duties that Home Care Aides perform.  It is also true because they choose to work with, to support, folks that they know have a high probability of losing at some time in the future.  Perhaps that loss will be to s skilled nursing facility or to a family home in a different location or -- the worst loss, of course -- the death of the client.

Professional caregivers know this, not just on the level of statistics and probability, but on a very personal basis.  When we interview the professional, experienced Home Care Aides that we want for Support For Home, one of the questions we always ask goes something like, "Why and how did you become a professional caregiver, and, after you learned how hard it is, why is this still your profession?"

The typical answer we get back, with sincerity, from the folks we tend to hire, is, "But this job isn't hard!  I love what I am doing."  Those same wonderful people will tell you -- have told us -- when someone they are caring for dies, "You never, ever get over it."  And, we know they do not get over it.  But their passion for caregiving carries them forward to the next or their other clients.  With grieving, yes, but without a loss of passion.

We would love to tell you their names and their stories, but privacy for both the employee and the client prevents that.  We will find a way.  But in the meantime, thank you to every single person who has taken care of a Support For Home client the way they should.  No, thank you to every professional caregiver out there who has worked at any other agency and made a positive difference in the lives of seniors and others who need help living at home. You have the second hardest job in the world.

Best wishes, Bert

These Aren't Scams, They're Comedy Bloggers

So, after reading my 9,427th email sent from everywhere from Algeria to Zimbabwe, telling me that a very small investment -- just a show of good faith, really, will secure my share of an unclaimed treasure worth $7,832,451.09, I have decided that these are really not scams at all.

I am now quite certain that these folks are simply fellows looking to become comedy writers for Conan's new show -- or maybe Leno's old, new show.  That part is not clear to me.  What is clear is that these are not simple scammers from Russia or Africa or North Dakota (well, I suppose some of them could be from North Dakota).  A few of them may be from Goldman Sachs.  The grammatical ability seems to match.

But clearly, they are not seriously inviting me to send over $50,000 to secure my good fortune.  I mean, for goodness sake, they must know I run a home care company, so there is no way I've got $50,000!  There is an old joke, about a New England dairy farmer who won the lottery.  He was asked what he was going to do now that he was rich.  "Well," he said, "I guess I'll just keep on dairyin' until it's all gone!"  He might as well have been in the senior home care industry.  :-)  If you are not doing what you are doing for passion, you are doing the wrong thing!  At Support For Home, it's all about passion -- for our client's and their desire to age in place -- in their own homes.

So, keep those emails coming guys.  When you are working 24x7, a little laughter goes a long way.

For the rest of you, if you don't agree with my theory, I've learned about $4,000,000 in Confederate money that we can split, if you just send me $50,000.  I need the money up front to send to this guy in Ukraine from whom I just heard who has a sweet deal for me.

Some People Understand It's About Passion

So, Support For Home is all about senior care and helping folks live at home by providing assistance with their Activities of Daily Living (ADLs).  Then why am I so excited about CopyBlogger and GuestBlogging, by Jonathan Morrow?  As far as I know, he has not written anything about elder care or health care reform or dementia.

Frankly, it is very simple.  Jonathan Morrow has passion.  You see it in his writing and you hear it in his videos.  His passion is about helping folks like me, who have the need to communicate about our own passions. 

In my case, it is the passion that led my co-owner and I to leave senior management positions at Intel Corporation.  We left to start a business in an industry that our own parents' stories told us was hurting.  We knew we were never going to make as much money as we did at Intel.  We did not care.  We had learned about the need so many seniors had for support of their own passion -- aging in place, in their own homes.

Jonathan Morrow is not trying to sell me turn-key social media / social networking marketing solutions tailored to the home care industry.  He is trying to help me -- and many others -- communicate my own passion and message.  I love it.

If you have passion and a message, check out what Jonathan has to say.

Best wishes, Bert

Social Engagement Critical in Senior Care

Thanks to Marc Onigman in National Senior Living Providers Network for bringing a medical study to my attention.  The information is not really "news" to those of us in the senior home care industry, but it is always good to spotlight it.

When we do an assessment (free, of course) of a new client at Support For Home, we cover three areas:

1. Homemaker Services -- Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) in the home
2. Companion Services -- ADLs and IADLs that involve our interfaces with others and outside the home
3. Personal Services -- ADLs and IADLs such as bathing, dressing, toileting

As we discuss the second category, we frequently observe a much smaller social calendar and circle of friends and acquaintances than is "healthy."  Of course, that is not surprising, since, as we age, we tend to lose family members and friends.  The challenge is for our clients, hopefully with our help, to renew and rebuild that circle.  If my friend Joe and I never get together any more, because neither one of us drives, that can easily be and must be "fixed."  A truly Comprehensive Plan of Care must be as focused on number 2, above, as on 1 and 3.

The study is as cautious as all of them are, in terms of cause and effect, but reports,

In a pooled analysis of 148 studies, having strong social relationships was associated with a 50% greater likelihood of surviving through follow-up (OR 1.50, 95% CI 1.42 to 1.59), according to Julianne Holt-Lunstad, PhD, of Brigham Young University in Provo, Utah, and colleagues.

The magnitude of the association puts social relationships on a par with quitting smoking and beyond obesity and physical inactivity in terms of relationship with mortality, the researchers reported in the July issue of PLoS Medicine.

In the senior care industry, we must all put even more emphasis on this issue and look for creative ways to increase social interaction and relationships for our clients and patients.  It is not just a matter of quality of life.  It looks pretty clear it is about quantity of life.
Best wishes, Bert

Federal Study on Aging Good, But ...

There are some very interesting data points in the recently published study, "Older Americans 2010: Key Indicators of Well-Being."  The study was put out by
The Federal Interagency Forum on Aging-Related Statistics.

As most of us are aware,

Americans are living longer than ever before. Life expectancies at both age 65 and age 85 have increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of 18.5 more years, about 4 years longer than people age 65 in 1960. The life expectancy of people who survive to age 85 today is 6.8 years for women and 5.7 years for men.

That is, on its face, a wonderful thing.  However, there are many implications that are a bit more complicated.  When one begins to look at the size of the senior population (including me), one's eyebrows begin to rise:

In 2008, 39 million people age 65 and over lived in the United States, accounting for 13 percent of the total population. The older population grew from 3 million in 1900 to 39 million in 2008. The oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 5.7 million in 2008.

The implication for Social Security is old news, but still a valid concern.  Less intuitively obvious, however, are some of the other issues.  For example, 42% of women 65 years of age or older are widowed (much smaller number for men).  76% of women over the age of 85 are widowed and 38% of men that age are widowers.  This has very significant meaning, socially.

Another set of issues involves the chronic medical conditions which face us as we age.  The chart below, from the study, has a great deal to say about that:

The number of seniors with multiple chronic conditions is clearly evident when one looks at the percentages for each.

One of the areas that the study clearly fails in, at least in my judgment, is dementia, including Alzheimer's.  Statistics are really not reported and analysis is missing.  As the study itself says,

While there are several studies which report estimates of the prevalence of Alzheimer’s, one of the major barriers to reliable national estimates of prevalence is the lack of uniform diagnostic criteria among the national surveys that attempt to measure dementia or Alzheimer’s. A meeting convened by the NIA in 2009 to describe the prevalence of Alzheimer’s concluded that most of the variation in prevalence estimates is not driven primarily by the reliability of the measures or instruments per se but by systematic differences in the definition of dementia.

This is very, very disappointing to all of us involved in senior care.  Until we really gain an understanding of what it means and what the impact is, we will not do the best job of addressing the problems of dementia and Alzheimer's.

An area that the study better addresses is the need for assistance with Activities of Daily Living (ADLs).  That need is the real basis for non-medical home care existing in the first place:

It is interesting that the largest growth in meeting ADL needs is in the area of equipment.  That is one reason we work so closely with mobility and durable medical equipment suppliers for our own home care clients.  We have to understand and be able to address the total universe of need.

All in all, it is a very good and interesting study.  Check it out.

Best wishes, Bert

What Does Information Technology Have To Do With Senior Care?

I owe this article to my co-owner of Support For Home In-Home Care and spouse.  She started vibrating at a dangerous frequency recently when we encountered a problem with a vendor.

The topic is not one which may be intuitively obvious.  It is about IT (Information Technology) and how it relates to customer service, but even more importantly to safety of our senior and other clients in the home care industry.

As IT professionals for 25 years, ourselves, we have seen Information Technology evolve to be a utility that is expected to work all the time.  We tend to think of reliability similar to the phone system in our homes or the gas / electricity supplier.

That having been said, what does IT have to do with senior home care?  Actually, it has a lot to do with being able to deliver high quality, trusted care.  Our computerized scheduling system (from vendor "A") is integrated with another program called Telephony (from vendor "B").  Our caregivers call the computer (via our toll-free number) using client’s home phone when they arrive to "clock-in".  When a shift is over, they call (using Telephony) again to "clock-out".

If the Home Care Aide does not clock-in using the computer system, those of us in the office receive an email telling us that the caregiver may not be with the client.  The Support For Home administrative team then calls the client's home to find out if the caregiver has forgotten to clock in or was delayed in getting to a client’s home. 

Since we are providing critical support to our clients' Activities of Daily Living (ADLs) , enabling them to safely live at home, being there on time when we say we will and working the stipulated shift hours are vital components of home care.

This past Sunday to Tuesday, we encountered an issue with the Telephony computer system, with caregivers encountering frequent but intermittent busy signals. Our scheduling system vendor only provided technical support on the phone Monday through Friday, 8:00 am to 2:00 pm. Of course, we have Home Care Aides scheduled with clients 24 hours per day, 7 days per week.

We contacted our scheduling system vendor about the issue on Monday morning and were told at 1:00 pm that the problem was resolved.  The technical support said "We have no control over the situation, as Telephony is provided by a separate information technology vendor."  When we inquired about service level agreements and support between this scheduling vendor and Telephony, the person said you have to talk to our sales person.

As a customer, we are never going to be satisfied with this answer. We realized by 2:00pm that the problem was still not resolved and we had to wait yet another day and contacted them on Tuesday. The problem was only finally resolved on Wednesday.  The email response we received was that it was some other company's issue and "we have no control over it."  This is called not accepting responsibility.

In the eyes of the customer, when he/she buys service from a company, that company is responsible for the service delivered, period, no excuses.  When the company further contracts and sub-contracts services, the customer does not care about everything that goes on behind the scenes.  The company is responsible for managing its vendors and performance.  If the vendors do not perform, the company looks bad.  Worse than that, the client's security and quality of life may be negatively impacted.

A mistake may be made by a caregiver or an office staff, but as the owners of Support For Home, we are responsible.  If our scheduling software with Telephony does not alert us of a problem, we can miss our commitments, so we are making too many phone calls to clients, all of them are saying, "Yes, the caregiver is here."  But we have to add a minor disruption to their lives to ensure all is OK.

To our client, Support For Home is responsible for their care, and they are right!  At our agency, we will never pass the buck.  We just wish other companies, including those in information technology, would behave the same way, with the same level of passion, customer service and sense of responsibility.

OK, This Aging Issue Is Personal!

As I have gotten older, so have my eyes.  Yes, that is a truism, but that does not make it unimportant for seniors -- and those soon to be seniors.

I have more trouble than many folks, because I am naturally (pre-cataract surgery days) very nearsighted.  That means that my eyes are naturally longer than normal.  That puts me at much greater risk for things like detached retinas.  It also makes me much more susceptible to macular degeneration caused by bleeding into the retina.  As one retina specialist told me, you only get so many cells to "wallpaper" the back of the eye, and if they get stretched to much, there can be bleeding.

In my case, there has been bleeding, in both eyes, over the past six or seven years.  The first time it happened, in my right eye, I was pumped full of an expensive chemical and got to stare into a laser.  Fun.  That had to be done several times.  This year it happened in my left eye.  Advances in medicine meant I got to have a needle poked into my eye once a month for three months.  Also really fun.  At this point, I do not see straight lines anymore, but at least I see.  I am a firm believer that the earth is curved, if not round.

Now, aside from fascinating you with my life story, what is the significance of all this?  Really, it is two-fold.  The first is that these issues happened after I turned 50.  The older I get, the more likely they are to recur and get worse.  That fact is another reason why we founded Support For Home In-Home Care.  The problems I am having now and will have as I get older are not news to some of our clients.  Their desire to live at home is threatened by declining eyesight.  Our support of their Activities of Daily Living (ADLs) is critical to their success. 

There are many excellent sources about macular degeneration on the Web.  One such source is Wikipedia.  The National Eye Institute of the National Institutes of Health has excellent information and links.

In my case, I have had good medical insurance and been able to pay for great treatment for my eye problems.  For many seniors, that is not the case.  One program seniors and family members should check out is EyeCare America.  Aside from excellent information, many seniors may qualify for a free eye exam or even up to a year of free care from volunteer ophthalmologists.  It is a great program.  Check it out and keep an eye on this blog for more information on issues of aging.  Sorry for the pun -- could not help myself.

Best wishes, Bert